HomeMy WebLinkAboutR2021-0447 - Permit ApplicationDocuSi_ n Envelope ID. C8762540-E867-4DC2-AOF5-51 E5B221 AAEA
Escrow Company: Key Escrow,lnc. Escrow # 005641 -BR
Escrow Address: 450 Newport Center Drive, 230 City: Newport Beach
State: CA Zip Code: 92660 Escrow Phone: (949) 698-1960
Email Report To: corina(c,keyescrow.com
for Inspection Call (Name):
Direct
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/ Agent's signature to authorize inspection: Date:
Agent's signature to decline inspection:i u.„,S zsM„„,,,x Date:
6/16/2021
Account #2900-5005...........Make checks payable to CITY OF NEWPORT BEACH
KkGEIVCD
COMMUNITY
DEVELOPMPNI
Print Form City of Newport Beach
JUN
COMMUNITY DEVELOPMENT DEPARTMENT
% 2021
y�,�4p nip g¢�, BUILDING DIVISION
p V g o�tp,y tUl/-g- ly 100 Civic Center Drive I P.O. Box 1768 Newport Beach, CA 92658-8915
RBRd F V (�/ u 1 V w .newportbeachca.gov (949) 644-3200
OITY OF
/P
Application for Report of Residential Building Records %POPT Bet 0\.\
Application Fees Single Family Res/Condo (1 unit) - $165.00 Notice:
Duplex (2 Units) - $192.00 Application with insufficient fee
payment
More than 2 units - $192.00 + 11.00 per unit over 2 or incomplete will be returned
Reinspection Fee $88.00
Please type or print and complete all information
# of Units: Address: 1009 Dolphin Terrace City: Newport Beach State: CA Zip:
Property Owner: Catherine Emmi Zip Code:
OwnerAddress: City:
State: CA Zip Code: Home Phone:
Owner's Authorized Agent: Evan Corkett Work Phone:
Agent Address: 450 Newport Center Drive, suite 100 City: Newport Beach
State:CA Zip Code: 92660 Agent Email Address:
Escrow Company: Key Escrow,lnc. Escrow # 005641 -BR
Escrow Address: 450 Newport Center Drive, 230 City: Newport Beach
State: CA Zip Code: 92660 Escrow Phone: (949) 698-1960
Email Report To: corina(c,keyescrow.com
for Inspection Call (Name):
Direct
CONSENT TO INSPECT (FORM MUST BE SIGNED & DATED BELOW)
I authorize inspections and re -inspections of the property listed above. I understand that if Building or Zoning
violations are discovered I will be responsible to correct said violations.
Owner/ Agent's signature to authorize inspection: Date:
Agent's signature to decline inspection:i u.„,S zsM„„,,,x Date:
6/16/2021
Account #2900-5005...........Make checks payable to CITY OF NEWPORT BEACH